Diagnosis and management of eswl–induced significant perirenal hematoma
Shih-Hsun Lin, Yan-Wen Zhang, Po-Huang Chiang, Wen-Chou Yang, Chun-Chien Hsu, Wei-Jing Li, Yao-Chi Chuang, Yen-Ta Chen, Yuan-Tso Cheng,Chih-Hsiung Kang
Department of Urology1 and Extracorporeal shock wave lithotripsy2, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Extracorporeal shock wave lithotripsy (ESWL) is a well-known and highly effective treatment for removal of kidney and ureter stones. However, several complications after ESWL have been reported including renal hemorrhage. The purpose of this study is to evaluate and manage ESWL-induced perirenal hematoma in a single medical center.
Material and methods:
Seventeen patients was recognized among 15961 patients who underwent ESWL for the treatments of renal and ureteral stones by either LITE-MED Model No:LM-9200 or HMT Lithotron during 2003~2014 . The stones were targeted fluoroscopically and shocks were delivered at 3000 shockwaves with ramping energy settings of 15~18 kV. The patients were found to have perirenal hematoma via abdomen computed tomography (CT) or ultrasound either at emergency room or outpatient clinic.
The incidence of ESWL-induced significant perirenal hematoma was 0.1%. Among the 17 patients, no one was treated for ureteral stones. Mean age was 56.2 ± 9 years with 14 male and 3 female. Mean stone size was 13 ± 8mm (range 6~37mm). All patients had flank pain on the treated-stone site, rapid pulse rate (>100bpm), and pale appearance. The mean dropped hemoglobin level was 5.8 g/dL (range 3~7.7g/dL). (From mean hemoglobin 14.8 g/dL dropped to 9.0 g/dL, p value< 0.01) The mean diameter of perirenal hematoma was 10.5 ± 2.4cm (range 6.1 ~14.0cm). Fifteen needed to hospitalize for fluid resuscitation. Eight needed blood transfusion (Mean 4±2.8units). Among them, one received angiography with arterial embolization due to potential coagulopathy caused by liver transplantation. No one needed further surgical interventions.
Early recognition of significant perirenal hematoma induced by ESWL is important. Pain, pale, rapid pulse rate (3p symptoms) and dropped hemoglobin level (>3 g/dL) suggested this severe complication. Rapid fluid resuscitation and blood transfusion could treat most of the patients. Arterial embolization might be necessary for the patient with potential coagulopathy.